Our Baby Ally Birth Story

She came a day late, at least as far as my estimated date of delivery (EDD) goes.  For Mommy, she could come out any day she wishes to and it would still be perfect.  However, I had to deal with the inevitable proposal of induced labor and I was once again adamant to wait for another 2 weeks.  But of course, that did not keep me from worrying so I was glad nonetheless that Baby Ally chose to support Mommy.

In the wee hours of November 23 around 4:45am, I woke up to some mild contractions.  Since I’ve been getting Braxton-Hicks the last few days, I decided to wait and see.  An hour later, it regularly came at 12-15 minutes apart so I decided to inform my husband and we started to time the contractions.  We were taught from our hypno-birthing class that the duration of the contraction is more important than the interval.  If the contraction from start to peak lasts for 60 seconds, then I would definitely be in active labor with at least 4cm dilation.  We do not want to go to the hospital prematurely and run the risk of medical intervention. The less time spent in the delivery room the less chance of this from happening.

Around 1pm, the duration and interval were there.  I actually wanted to stay longer at home where I was more comfortable and wait till maybe I was around 6cm dilated (contraction from start to peak lasts for 60 seconds or more but interval closer at 3-5 minutes).  Alfred however wanted to go having learned from our class that the body has a memory and that labor the second time around is much faster.  He was scared of ending up delivering the baby by himself in the car! 

En route to the hospital, Alfred and I went through what we have agreed.  I will be in no position to assert what I would want as I will be focusing all my energy on giving natural drug-free birth to our baby.  His role as the keeper of our birth plan is to make sure that it is being upheld and followed.  As second time parents, we were more prepared and confident this time.  We believed 101% we can achieve gentle birth for our daughter.  We arrived at the hospital around 2pm and found out I was 3.5-4cm dilated, as expected.

Once settled in our delivery room, I did everything I practiced from our hypno-birthing class.  I put on my headphones and lulled myself in hypnosis.  I was very happy that I was a free mom in labor – free from IV drip and monitoring machines, free to eat and drink anything I wanted and most importantly, FREE TO MOVE AROUND.  I was in every position I felt instinctively right.  Walking around, rotating on the birth ball, sitting and meditating, going to the loo constantly (we naturally relax when we are on that toilet seat right?), I was on all fours, slow dancing with Alfred, I was even lying down on the floor at one point!

Opting to wear my own clothes (with front zipper for easy skin-to-skin) to feel at home.

Still joking around at 4cm dilation

Having hot milo and biscuits while on the birth ball

Now, it would be utopic to say that the pain did not hurt.  It was manageable.  The deeper I went into hypnosis, the lesser the pain became but it took a lot of concentration.  I visualized that every contraction pushed my baby closer and closer to me.  I remember coming out of my hypnotic state and immediately felt the immensity of pain that I shouted, “baby is coming out!” only to find out I was still 7cm dilated.  Again, I pictured in my mind how my baby and I are working together to achieve the harmony of giving birth – naturally.  I trust my body and my baby.  We will get there.

Contractions starting to get intense

Slow dancing gives off endorphins for that nice physical touch

Deep in hypnosis at 7cm

At 9cm, trying to sleep off contractions and getting extra confidence from partner

Then came the funny and unexpected part.  Thanks to our hypno-birth teacher, she taught us that although most hypno-births are quiet and peaceful, at the end of the day, moms should trust her instinct on what she felt like doing because to each her own.  And that was exactly what happened to me.  At 9cm, I suddenly lost control (probably the adrenaline kicking in) and was shouting instructions to everyone around, even to my doctor.  At 10cm, my water bag was still intact so I gave a go ahead signal to break it and yelled “Doc, yes! Break it!” and  “Do an episiotomy now!”  I really felt the head was too big for me and I knew I would tear.  All these requests were against my birth plan but I guess I was too aggressive to be resisted! Haha!

After so many pushes, our precious baby girl finally came out at 8:11pm, all 7.1 pounds of her!  She was brought to my chest for our skin-to-skin contact and the most amazing thing happened.  She breast crawled and self-latched!  Our eyes met and it was truly a dream come true!  Daddy Alfred waited for the cord to stop pulsating (around 3 minutes) before he cut it (for delayed cord clamping benefits to the baby).  And because she was big (relative to my diminutive size), I bled profusely and was administered with pitocin to regulate the blood flow and the placenta came out as well (my only regret was I did not get the chance to see the placenta that nourished our baby for 9 months).  After everything settled down, Daddy Alfred had his skin-to-skin contact with Baby Ally too.

Self-latched after skin-to-skin contact

Skin-to-skin with Daddy too!

So happy with our doctor who honored our birth plan

My husband and I were so proud of each other.  It was really a team effort.  He did a very good job too.  I could hear him giving instructions to dim the light when Baby Ally came out, asking all measurements to be done later so I could bond more with our baby and making sure the baby was with us the whole time.  Baby Ally slept with us that night and for the rest of our hospital stay (she did not see the nursery room except for some quick protocols).  Looking at her serene and contented face, it was truly everything what we have wished for and more.

Our peaceful baby girl

She slept the night with us

Imagination Goes A Long Way

I took an early leave to prepare for my upcoming birth and to take extra time to bond with my firstborn.  Taking care of her when I am so heavy at 39 weeks is a challenge. I know toddler stage is probably the most active and explorative stage but believe me when I say she is extraordinarily active.  Family and friends who have been with her can attest to this.  Not that I am complaining, my pediatrician comforted us haggard parents that “an active body is a sign of an active mind”.

Unable to keep pace with her moving around so constantly, I employed the best arsenal I have – my colorful imagination.  Reading time with mommy makes her very excited.  She would quickly grab as many books as she could and sit comfortably on my lap.  Away we go to exciting jungles where lions and elephants roam the great expanse of Africa.  How Felix the fire truck saves the poor dog from a burning building or how Peter Rabbit narrowly escaped the wrath of Mr. McGregor!  Elaborate details, exaggerated sounds and body gestures would literally make her eyes open wide and she would exclaim “Oh no!” And from her expression, I can tell that she is in that wonderful magical place of fantasy.

I know recently that there is this trend to expose children or even babies to early academic training.  Emphasis is placed upon pushing them to learn ABC’s or count numbers at a very young age – and this age gets even younger as time goes by.   We are living in such a competitive world that we parents are afraid that if we don’t push them early enough, children might fall behind and not excel in school.  I would know. I tried flashcards and Baby Einstein videos (which by the way is being recalled for recent studies showing its ineffectiveness) as early as 6 months to ‘jumpstart’ her early learning.  I found out that nothing could be further from the truth.  Apparently, there is no scientific evidence that early academic training works.  In fact, children turn out to be more stressed and less creative.

In the book “Raise a Smarter Child by Kindergarten” by David Perlmutter, M.D. and Carol Colman, it expounds that, “the choice of early academic intervention, especially the kind of “drill and test” that are so popular today is the wrong approach.  Instead of building great brains, we are merely creating tape recorders that can regurgitate information but cannot synthesize it to come up with new ideas.  At a time when a child should be encouraged to be creative, which is the foundation for advanced thinking, many children are being loaded with facts.”

It goes on to say that, “any child can memorize his ABC’s or learn to count if he is drilled long and hard enough, but these are not effective brain-building activities.  Creativity is at the core of all problems, writing an essay, or designing a science project.  For example, if your child is confronted with a new challenge, such as a difficult math problem or a challenging essay, what does he need to succeed?  First, he must be comfortable with being in a novel and challenging situation.  This comfort level is fostered during the first five years by allowing children to explore challenging situations, engage in creative play, and learn that failure is an option.  In other words, it’s ok to take intellectual risks.   It all requires creativity.”

This is music to my ears. Fostering creativity is what I do for a living. Almost anything can be used as a prop for imaginative play.  In fact, the simpler the better and it can take us as far as our imagination goes.  A big empty box is especially our favorite.  It transforms from a hot air balloon, to a train, to an airplane and transports us to new exciting places.  Even our pretend play – from being a princess to a tiger, the hunt for what material to use and making them is in itself part of the creative process.

The versatile pillow case as a Queen's Cape or a Tiger's Tail

Just the other night, we had trouble putting her to bed as she was used to being carried and danced to sleep by her “yaya”.  Her dad was getting tired carrying her so I asked him to put her down.  As expected, she became fidgety, tossing, turning and wanting to go down the bed.   With Alfred starting to get exasperated, I quickly exclaimed to her, “Ava, tell Daddy what an exciting day you had!”  That got her attention and we both chimed in making heightened remarks like “Really?! You saw a squirrel climbing the tree?!  Was he looking for his mommy?” and so on.  We would make up stories and before we know it, she was off to dreamland.  Whew!

So all these heavily marketed learning paraphernalia and expensive electronic toys are not really necessary.  Aside from taking so much space in our tight living space, Ava gets bored with them so easily.  It is quite restricting too.  With creative play, I engage Ava to use her imagination and most importantly, to ask questions as these are sometimes more important than knowing the answers.  Albert Einstein did say that, “Imagination is more important than knowledge.  For knowledge is limited to all we know and understand, while imagination embraces the entire world, and all there ever will be to know and understand.”

Real Reasons for Cesarean Sections?

Has the reproductive system of the 21^st century woman suddenly malfunctioned?  Has it suddenly ceased to innately give natural birth?

How else can we account for the alarming increase of induced and caesarean births?  The World Health Organization (WHO) recommendation for caesarean section rates fall between 5%-10% and yet WHO survey around the globe affirms C-section rates at ‘epidemic’ levels. 

• Nearly half of all births in China are delivered by cesarean section, the world’s highest rate — a shift toward modernization that isn’t necessarily a good thing.

• The WHO, which reviewed nearly 110,000 births across Asia in 2007-2008, found 27 percent were done under the knife. 

• In the U.S., C-sections are at an all-time high of 31 percent. A government panel warned against elective C-sections in 2006.

• In Latin America, C-section rates in all eight countries surveyed earlier by WHO were 30 percent or higher — similar to the U.S. rate.

These figures are very frightening for an expectant mom like me who wishes to give natural and gentle birth. Left and right, friends and loved ones end up birthing under the knife.  You hear the all too familiar reasons – fetal distress (which prompts one to wonder why babies too have forgotten how to be birthed), low amniotic fluid, going past due date, failure to progress, repeat cesarean births… reasons which are highly debatable in the first place.  Still, these don’t explain why such problems are so rampant nowadays.

These selection of books have given me so much confidence in natural birth.

I decided to dig deeper. I searched for books written by doctors themselves who validates the importance of natural birth from a medical point of view.  After having gathered sufficient knowledge straight from the horses’ mouth, I can, to a large extent, pin it down to two major factors:

TESTS, TECHNOLOGY AND INTERVENTIONS

Take the case of continuous use of external fetal monitoring (EFM), where two large straps are placed around the abdomen to detect baby’s heartbeat and uterine contractions, which has become standard practice. In The Birth Book by William Sears, M.D. and Martha Sears, R.N., it asserts that “the problem with EFM is that what the monitor says and what’s going on with the baby are not necessary correlated. Not everyone is equally skilled at interpreting nor is there uniform agreement as to what the different patterns mean. Also, recent research suggests that damage to a baby’s brain (e.g. which later causes cerebral palsy) occurs mainly before labor begins and is usually not due to insufficient oxygen during final passage. Indeed, when EFM was introduced to hospital procedures, cesarean section rates doubled, yet babies did not turn out any better”.

Another device that found its way into standard obstetrical practice is the regular ultrasound check-up.  Although it is very useful for pregnancy with complications, it has, however, become an unlikely tool for grounds of labor induction and cesarean births on an otherwise healthy pregnancy. Responsible for determining estimated delivery date (EDD) and amniotic fluid level (AFL), it has largely contributed to the rampant induction of labor for supposedly overdue babies and low amniotic levels despite not being backed up by studies and statistics to necessitate such procedure.  What about scheduled cesarean sections for breech babies when there is still time the baby will turn?

OBSTETRICS ‘FEAR OF MALPRACTICE’

Modern society’s notion is that the more we intervene, the better for the baby.  Doctors test, monitor, measure, and invade to try control every aspect of pregnancy and delivery.  Intervention then becomes an option if birth doesn’t go according to a predetermined timetable.

According to The Birth Book, fear of malpractice is a contributing factor to the cesarean epidemic.  If a doctor “did everything” including a section and the baby was still less perfect, the jury is less likely to find the doctor at fault.  In fact, obstetricians believe that number of surgical births will be cut into half if not for the legal consequences hanging over their heads. This succinctly explains the reputed phrase “the only cesarean I’ll be sued for is the one I don’t do”.

In the comprehensive and well researched book “Gentle Birth, Gentle Mothering” by Sarah J. Buckley, M.D., many commentators have recognized a link between high cesarean rates and having obstetricians as primary birth attendant:

“There is a higher level of comfort that obstetricians feel with the risks associated with cesarean deliveries compared with those associated with vaginal deliveries. In contrast, low-technology models of care (midwifery, birth center, homebirth) are at least safe, involve fewer interventions, and have lower cesarean rates – typically below 10 percent”.

The combination of the ubiquitous use of technology and fear of “not intervening enough” is a powerful force behind the alarming rise of surgical births. As Dr Sears points out, if technology cries wolf, the ultimate question is what to do with the findings -is it just an unusual pattern or the baby is really in trouble?  Not wanting to take chances, the hospital path from delivery room to operating room becomes a road frequently traveled.

Technology is perhaps the greatest paradox of our modern lives. It has given us so much, yet it has also stripped us some valuable wisdom from our modest past. In the name of ‘extra precaution’, this has given way to routine tests, invasive technology and unnecessary interventions.  Never mind that for centuries babies were birthed in the safety of their homes and mothers trusted her instincts.  She felt connected and well attuned to her own body and baby, a time when women felt most empowered.

Ava's Gift of Life

It took us more than a year to conceive our first-born.  Like most couples who plan to have a baby, the unwanted visitor that comes month after month translates to a growing anxiety.  As time ticks by - pressure overrules passion, and schedule takes over spontaneity.  The whole thing starts to feel like a chore, more than anything else.  So when we finally got pregnant with Ava, we wanted to give back as a sign of our gratitude.

The opportunity presented itself when we attended a childbirth education class sponsored by the hospital.  One of the topics was the option to save the cord blood of the baby (extracted from the umbilical cord right after birth), which is currently being used to treat certain cancers and blood disorders.  Mothers can either deposit it in a private bank for family’s exclusive use, or donate it in a public bank where a match recipient can avail of the “gift of life”.

So we quickly got in touch with Singapore Cord Blood Bank (SCBB), the only public bank in Singapore and in the Southeast Asia Region.  To our surprise, donating wasn’t so easy after all!  To start with, not everyone can donate.  My husband and I had to go through a rigorous “interrogation”, detailing our health and lifestyle background, including that of our parents.    Furthermore, I had to sign a disclosure that in the event genetic or infectious diseases are found in my blood, this has to be brought to medical attention and deportation is a possibility.

Unfortunately, the saga didn’t stop there. They had to extract at least 30ml of blood while I was on active labor!  I was already at my wits end riding through contraction after contraction and the nurse, for some reason, had to poke me thrice just to get it right! But that’s just me.  I found out belatedly that baby Ava had her share of sacrifice too.  Because a sufficient amount of cord blood had to be collected, her cord was clamped immediately after birth and at least 1/3 of her blood was instead taken away. This was the heartbreaking part for me.

A thank you (or sorry) card for poking me thrice while on active labor?

According to a study published in the Journal of Cellular and Molecular Medicine, delaying cord clamping for at least 30 seconds reduced incidences of intraventricular haemorrhage, late on-set sepsis, anaemia, and decreased the need for blood transfusions.  Moreover, it could reduce the infant's risk of many illnesses, including respiratory distress, chronic lung disease, brain haemorrhages, anaemia, inflammatory condition sepsis and eye disease.

I find comfort with a Cochrane study which shows that although there is a significant increase in newborn haemoglobin levels in the late cord clamping and cutting group compared with early cord clamping and cutting group, this effect did not persist past 6 months.

Also, the American Academy of Pediatrics actually recommends public cord blood banking over private, if the parents do opt to store the cord blood.  The likelihood that they can use their own cord blood is slim, since whatever condition that will afflict them is already inherent in their cord blood cells.  Secondly, by increasing the pool of cord blood available to public, this gives a higher chance of a match with a recipient who is in need of transplant.  

However, this policy has been greatly contested arising from the recent development on stem cells research. Researchers around the world are unlocking the autologous (the patient’s own) use of cord blood stem cells for cellular therapy to help repair failing organs and tissues. In fact, in 2009 a first successful treatment of cerebral palsy was performed in Singapore by infusing the little girl's own cord blood. Her condition has greatly improved post-treatment.  Indeed, positive results on regenerative cell research offer such promising possibilities.

Going through these salient points from various angles have only raised more questions than answers. Do we then go for delayed clamping and avail upfront the benefits it offers or do we clamped it early to extract valuable cord blood and store it in a private bank this time and be assured that our family has the insurance of health?

After much thought and discussion, we decided that prevention is always better than cure. To begin with, the baby ought to benefit from what is rightfully hers.  We cannot compromise the present of what might and could happen in the future.  My husband, bless him for having a big heart, also feels that if we do have to extract the cord blood, it still has to go to the public bank for we cannot store it exclusively when a match recipient might have a dire need for it.

AFTERNOTE: It is with great pride that a year after, Singapore Cord Blood Bank called me to say that Ava’s cord blood and my blood sample passed all stringent requirements.  After confirming that Ava is in great health, I consented to use it for a possible match with a baby who needed it. Her donation, after all, was all worth it. A precious life was gifted to us, and we can only pass it on.

My Birth Plan

My first birth was great albeit with extra pain brought about by early artificial rupture of amniotic membrane (which happened without my consent), I believe it could be greatly improved.  After countless hours of research and 12.5 hours worth of hypno-birthing classes, I am now more prepared mentally and physically to give natural birth the second time around.  Now that I know better, I want to do better. 

Having a birth plan is not so straightforward.  Firstly, some doctors are not so keen on it because it deviates from their routine procedure.  But that is exactly the point, every mom gives birth differently so one mold does not fit all.  Secondly, the care providers and hospital policies are, if not oblivious, unreceptive to such requests.  Third, keeping the birth plan short is a challenge.  The more you know, the more you realize that much of the processes and procedures greatly affect the quality of birthing and most importantly the baby’s first experience earthbound. 

I will be absolutely thrilled if all goes to plan. My husband and I, however, have discussed on how we would handle the unexpected, when it does happen.   Thanks to our hypno-birthing class, we come prepared and have an acronym for it - BRAND.  Remembering what the acronym stands for is very helpful when medical intervention becomes an option: to ask 1) the BENEFITS of the solution being offered, 2) what are the RISKS of the provided solution, 3) are there any other ALTERNATIVE solutions, 4) what happens if we do NOTHING and stick with the birth plan and 5) how much time do we have to make a DECISION.

At the end of the day, it is about making an informed decision.  I am of course not against medical intervention.  In fact, we are very fortunate to live in a time when such interventions are readily available in order to save a mother or baby’s life.  What we don’t want is treating an otherwise normal physiological event into a medical procedure, when labor inducement is introduced even when mom and baby are doing great or caesarean is automatically performed because of breech position without even exploring options - when everything is done so routinely. 

This is the purpose of the birth plan – to give mothers the “voice”.  It is a conviction that giving gentle births to our babies is a step towards a more compassionate world. 

ADMISSION STAGE

• To be assigned a nurse who is partial to natural birthing.
• To self-hydrate and decline routine IV prep upon admission.
• To have intermittent monitoring (EFM) of FHR after the mandatory twenty-minute strip at admission.
• To be provided a labor room equipped with water tub.

DURING FIRST STAGE LABOR

• The patience and understanding of care providers to support our wish for natural birth as much as possible.
• To continue with intermittent monitoring (as agreed with doctor every 30minutes to 1 hour) only.
• To be allowed to walk around or move during labor.
• To be allowed to eat and drink, without the use of IV drip unless medically necessary.
• To be fully consulted before any medical procedure is to be done (e.g. amniotomy, augmentation, membrane stripping).

DURING BIRTHING

• To be allowed freedom of labor positions of choice (as discussed with my doctor, my pain tolerance and stamina is higher when I am on all fours).
• To be allowed the use of HypnoBirth breathing techniques.  Mother-directed pushing.
• Episiotomy only if necessary and only after discussion.
• To allow the gentle descent of the baby – no pulling.  If possible, dim the bright lights temporarily at moment of birth and until baby is moved to mother’s chest.

FOLLOWING BIRTHING

• To refrain from suctioning baby’s nose unless medically necessary.
• Immediate skin-to-skin contact, with baby placed on mom’s lower chest.  Dad joins in this bonding by placing hand on baby’s back under warming blanket.
• To be allowed mom-baby bonding as long as possible and delay measurements of weight, height, etc… and other procedures.
• Delayed cord cutting.  Dad will only cut cord after it stops pulsating.
• To allow vernix to be absorbed into baby’s skin; delay “cleaning”.
• To refrain giving the baby glucose water.  Mom to breastfeed exclusively.
• In the event of C-section, the Dad to be allowed to remain with mom in the operating and recovery room.
• Dad will hold the baby after C-section and bring baby to Mom for viewing and eye contact.  In the absence of urgency, Dad continues to hold baby for bonding.

On Raising Babies and Buildings

It’s been over 2 weeks since my last post and I’ve been itching to write, if not for my extended mileage in the office.  It’s one of the many endless overtimes that architecture is infamous for.  I’d say the more developed the city is, the more impossible the deadlines are. Whoever starts a 17-block condominium from scratch and targets to launch in 4 months time?  It does not come as a surprise that repeated visitors to Singapore are constantly amazed to see the city transform overnight!  The construction industry here gives the hard-working ants a run for their money.

When my supposedly half-day work stretched to whole day for two weeks running, I feel guilty that my little girl has been spending all these time alone in the house with her ‘yaya’ (the most difficult part of living abroad – non-existent extended family to help look after her).  However, when I reach home, I also feel guilty knowing my colleagues will be spending the night AGAIN in the office and I know so well how an extra head and pair of hands make a huge difference.  Not that they mind, on the contrary, they are actually very supportive.  I am also pregnant, after all.

I realized after reading the book, “What Happy Working Mothers Know” a New York Times Bestseller by Cathy L. Greenberg, Ph.D. and Barrett S. Avigdor J.D., a working mom is synonymous with being a guilty mom.  It inevitably goes with the territory.  The gist is to find the elusive ‘balance’ of work and home and most importantly to stay happy.   The mother sets the emotional climate in the family and activities at home mainly revolve around her.  Thus, it is imperative that the mother does what is in line with her values.  If she finds contentment and feels her work, to a large extent, defines who she is, then she should do it.  No point in forcing the issue of being a full-time mom just because society expects this of her and is unhappy while taking care of the baby.  I think it does more harm than good. 

Having said this, I made a self-assessment to find out what truly makes me happy.  Without a doubt, being with Ava and seeing her grow more beautiful each day - inside and out, and knowing that I am an active participant, is what truly makes me happy.  But in all honesty, I also realized that I could not do it the whole day.  I need to go out there – design buildings and see them built.  It gives me renewed energy which I believe benefits Ava too.  This is mainly the reason why I opted to go for a part-time job.  It is an attempt to bridge the gap between two ends of the spectrum – the career-oriented working mom and the full-time homemaker.  It is the perfect compromise.

How do we deal with feeling guilty then?  The book emphasizes on prioritizing what matters most, on setting a simpler goal each day and acknowledging achievements no matter how small.  If it means putting my career on a backseat for the meantime, so be it. When I was pregnant with Ava, I had to give up a project I designed from scratch and oversaw the construction for 2 years.  With the pending birth of my second, I am slowly turning over my current project too.  It frustrates me not seeing it to completion.  It also means a stall in my career path.  But still at the end of the day, nothing compares to the milestones Ava achieves everyday and BEING THERE to witness it.  Priceless.

Construction of 30-Storey Residential Building before turning over to my colleague.

Ava helping Mommy with Grocery

This brings me to another point why being there for her at her early years is very important.  It is her formative years – when the window of opportunity to influence character and experience is greatest. The American Academy of Pediatrics defines early childhood as the ages between one and five years.  According to The National Scientific Council on the Developing Child, Harvard University, critical aspects of brain architecture begin to be shaped by experience before and soon after birth, and many fundamental aspects of that architecture are established well before a child enters school. 

The science of early brain development, established over decades of neuroscience and behavioral research, is sufficiently mature to support a number of evidence-based implications.  Central to this conclusion are the three core concepts: First, both brain development and behavior are shaped by experience over time.  Second, both the architecture of the brain and established patterns of behavior are increasingly difficult to change as individuals get older.  Lastly, it is more effective and more efficient to get things right the first time than to try to fix them later.

So spending plenty of bonding moments with Ava not only gives me joy and contentment, it’s practically sound too.  I want to get it right the first time and I have that big chance now.   This is the chance to instill the values that is important to our family - during the years she’s most receptive.  Jacky Kennedy Onassis once said, “If you bungle raising your children, I don't think whatever else you do well matters very much”.  Ava’s development in her formative years is definitely one of the constructions I don’t want to miss.

The Fear Monger

A few days ago, I received an invitation for a seminar entitled “Joys of Motherhood”.  I went online to register looking forward to topics on breastfeeding or perhaps on ways to bond with the baby, only to find out in dismay that the series of talks has nothing to do with the joys of being a mom.  In fact, it is entirely the opposite. 

1^st Talk: Emergencies in Pregnancy: Symptoms, Signs and Treatment

2^nd Talk: Pain Relief in Labor: Myths and Misconceptions of Epidural

3^rd Talk: Bringing up a Super-kid: Fact or Fiction?

4^th Talk: The Importance of Saving your Baby’s Cord Blood

5^th Talk: Protection Needs: Early Stage Critical Illnesses

What do they all have in common?  They elicit unnecessary worry for the mom-to-be.  They are under the assumption that pregnancy is NOT WITHOUT complications and moms should be wary of symptoms and its corollary treatment.  Not that these things are unimportant to know, I’m sure they are lifesaving for both the mom and her baby.  However, I feel that the emphasis should be on proper nutrition and exercise, on how to stay healthy mentally and physically during pregnancy, THEN maybe some very important emergencies to look out for.  I am bothered with how the medical industry has created this halo of fear when really 90% fall in into the category of normal or low-risk pregnancy.

What about the myths and misconceptions of epidural?  Again it instills in the minds of moms that labor is painful and scary, enough to warrant an epidural.  Yes, the talk is about pain relief in labor but why single out epidural?  Even if epidural has been improved over the years to debunk some fallacies surrounding it, the cons still outweigh the pros and the risks are very much real.  And whatever happened to breathing and visualization techniques anyway?  Lamaze and Hypno-birthing methods offer effective pain relief with far more benefits than the use of epidural.  In fact, the World Health Organization does not consider an epidural to be essential for care in normal birth.  

Clearly, this seminar is another venue for marketing.  As the talk culminates with the importance of saving cord blood and touches on the early stage critical illnesses and is hosted by none other than Cordlife itself, one can’t help but be skeptic of these seminars.   Are they truly meant to empower women to make informed and unbiased choices?  Are there any real seminars that do not come with the hidden agenda of product promotion?

This greatly reminds me of Dr. Grantly Dick-Read’s book “Childbirth Without Fear”, when he made this proposition:

“Superstition, civilization and culture have brought influences to bear upon the minds of women which have introduced justifiable fears and anxieties concerning labor.  The more cultured that races of the earth have become, so much the more positive they have been in pronouncing childbirth to be a painful and dangerous ordeal.”

“…This is not the purposeful design of creation.  Somewhere, for some reason, an interloper has crept in, and must be eradicated, through blindness and ignorance in the development of our civilization, has been allowed to grow and impede the natural course of events.”

The interloper, in my opinion, is the ‘medicalization’ of childbirth.  Somewhere along the way, we have somehow lost our bearing in the fast pursuit of modernity.  Yet, we need not go far for answers.  Since the time of antiquity, Aristotle already believed of the mind-body connection and emphasized the importance of deep relaxation during childbirth.  Hippocrates was the forerunner in giving out formal instruction of midwifery.  Soranus, who compiled writings of Hippocrates and Aristotle, stressed that needs and feelings of women should be properly addressed and advocated using the powers of the mind to achieve relaxation to bring about easy birthing.

Dr. Grantly Dick-Read went on to assert that, “Childbirth is not a physical function.  The drama of the physical manifestations has blinded observers to the truth – the birth of a child is the ultimate phenomenon of a series of spiritual experiences, from fantasy to fact and from fact to fruition… supreme human function must not be neglected or belittled by the subjective materialism of modern science.”

The good news is, over the last few decades, just as western medicine recognizes the limitations of treating the physical alone – they start to realize that the body-mind (and even spirit) connection has far more healing powers than previously given due credit (e.g. meditation, bio-feedback).  Women too are starting to reclaim ownership of her body.  Women are realizing that her body is perfectly designed and more than capable enough to give birth without fear – without anesthesia and medical intervention.

Attack of the Malls

Busy tapping the keyboards away one day, my hubby peeked over my shoulder and asked, “Is that for your blog? You might want to take a break from writing about natural birth once in awhile.  You know… from a reader’s point of view, it makes your blog more interesting”.

Hmmm… maybe he has a point.  I decided to indulge my number one fan.  After all, I do have “thoughts on natural birth AND BEYOND” as my title, don’t I?  The next question is - what should I write about?  As I am writing this now on a Sunday, the weekend is coming to an end and we are still deliberating where to bring Ava.  Going to the mall is always the least of our options and living in Singapore, which a local cab driver once described to me as “one big mall”, could be a challenge indeed.  You ask, why not go to the mall?  This is what my next article is all about. 

As an urban designer, the city is a dichotomy of the tangibles (built environment) and the intangibles (how people live).  One influences and impacts the other and vice versa.  In Davao City for example, the recent proliferation of national malls (a change in the physical environment) meant that people are patronizing the malls and is slowly adapting to a more metropolitan lifestyle.   

Sharing with Davao City Mayor Sara Duterte the importance of public spaces

Opting to stroll around in the mall compared to the city center or park is quite understandable.  The atmosphere is always maintained at comfortable level, it is sheltered from the heat and rain, and the presence of security guards and surveillance systems provides a safer environment.  In "Shop 'Til you Drop" by Evans, K.I. & Fraser, P., the mega shopping mall is seen as almost a city in itself.  Aside from the commercial facilities of retail, food and specialty shops, it also accommodates offices, clinics, cinemas and other entertainment amenities, making it a convenient one-stop destination.  Moreover, the opening hours are longer than most shops in the city center and it provides sufficient parking space.

The implication of such development however, is that the symbolic center of urban activity of the city, the public plaza, is slowly moving towards the shopping malls and its surrounding commercial districts. During such progression, the huge atrium of shopping malls is starting to gain popularity as a so-called “public” space.  Some of the civic events like inter-school choir singing or dance contest previously held at the plaza mayor are now being hosted in the atrium.  Gone were the days when people used to stroll or linger at the city parks for recreation.  In the book, “The Culture of Cities”, Sharon Zukin testifies that, “the culture of public space has become inextricably linked with commercial culture”.

This is where the conflict begins. Commercial culture gives off false impression that the goal in life is to make money and buy products. With parents tagging their children most of the time in the malls, kids are unintentionally and subconsciously pre-programmed to be consumers. Indeed, we are living in a high-consumption society.  Wall Street Journal noted that “Miss [Nancy] Drew wasn’t obsessed with her wardrobe, but today the mystery in teen fiction for girls is what outfit the heroine will wear next.”

Don’t get me wrong, I LOVE malls and I LOVE shopping too.  But times have changed, so much different from our simpler time. Kids nowadays are exposed to too much ads. Even if TV time is limited, the malls with its plethora of products provide an easy alternative. Furthermore, the tendency to indulge them with the latest character craze or too many toys gives importance to materialistic joys versus the good old feeling of, say, creating something.

Anyway, without getting too wired on this, I think that there should be a conscious effort to filter the kind of exposure they get and to provide as varied activities as possible. For us, it comes as a challenge since Ava’s Kindermusik and Little Gym classes are located inside the malls and we too, more often, fall prey to shopping needlessly.  

According to child psychologists, outdoor fun play still remains the best option for growing bodies.  Aside from the exercise they get, it develops large and fine motor skills as well as hand-eye coordination. That is why our weekends are always pre-planned.  From going to the beach or zoos, flying kite and playing ball at the park, watching orchestra, and so on, we hope that Ava appreciates the great outdoors and that this forms part of her many treasured childhood memories.

A visit to the zoo is our favorite!

Beach therapy from city living.

I just love the outdoors!

Ava and Daddy appreciating horticulture

My Breastfeeding Success Story

On this breastfeeding month of August, I decided to sit down and write these 5 salient points that made my breastfeeding a success. 

Belief that breastfeeding is the most natural thing in the world.

I personally believe that if the woman’s reproductive system can conceive and give birth, so can breasts produce milk.  It is the most natural thing in the world. It makes total sense too.  Nature provides mother’s milk for the baby to survive earthbound.  This is how man survived thousands and thousands of years.

As early as fourth month into pregnancy, colostrum is already produced.  From the start and all throughout gestation, breasts will enlarge, areolas darken and nipples become more erect to prepare for breastfeeding.  It will start to produce milk when hormonal changes signal the onset of labor, birth and delivery of placenta.  In fact, these internal signals are so well coordinated that if the baby is born prematurely, the mother produces milk with higher fat content to meet the baby’s special nutritional needs.  A mother’s body is indeed designed for breastfeeding.

Knowing more is succeeding more.

Knowing what to expect is key.  My milk only came out steadily on the 4^th day but I did not panic.  I knew that for the first few days, only colostrum will come out but this is ok since babies are actually born with enough nutrients to sustain themselves for a few days and that they need the rest more from the trauma of birth.  Milk will slowly build up as the baby continues to suck and stimulate the production.  I expected to experience painful engorged breasts somewhere on the 4^th day or so and knew that swollenness will be abated with cold cabbage and by massaging, latching and pumping.  I would have no idea how much milk the baby is getting so I counted her pee output – at least 4-6 wet diapers on the baby’s fourth day after birth and so on.  The more you know, the more you trust yourself.

I did miss out on one very important information, however, and it makes a rather funny story to share.  On our first night with baby Ava, the nurse kept waking us up every 2-3 hours to make sure the baby latched on.  I exclaimed indignantly to my husband, “Why does she keep on pestering us?!  Didn’t she know that we gave birth just a few hours ago and that we need our rest?!”.  To my great surprise and chagrin, I never knew that I had to breastfeed the baby every 2-3 hours nonstop - for months! 

Commitment or “can-do” attitude.

Knowledge on breastfeeding is apparently not enough.  I read an article sometime ago about qualities that company bosses are looking for when hiring a prospective employee.  Extensive knowledge and experience of course are essential but what sets someone apart is the “can-do” disposition.   It spells a huge difference when pressure and stress set in.  It means pursuing and excelling when the going gets tough.

In breastfeeding, two main challenges moms usually face are -  not getting enough rest and being so busy and stressed at work.  This results to lower milk output and has been the scapegoat for moms’ decision to stop breastfeeding.  I would know.  As an architect, most meetings happen outside the office and even at construction sites!  This means lugging my heavy dual pump, 8-pack battery adaptor and ice cooler bag with me.  In the middle of a meeting or site inspection, I find myself leaking and have to search for an extra room, most likely a storage room (I refuse to express in the toilet!) and would pump as fast as I could (turning the knob at high speed and strength – poor breasts I know!) while shoving a bread down my throat as I would be starving at the same time.

You get the picture.  It takes commitment.  There were plenty of times I would pump for a good 15 minutes and only 2oz. came out.  But I never got discouraged.  It only meant baby Ava needed to latch more and I needed to pump longer.  Of course, drinking more water and sipping more soup helped, too.

Support of husband and family makes all the difference.

Ask any breastfeeding mom and she will tell you that she could have not done it without the support of her husband or family. My sister breastfed her first for three years and still breastfeeding her second one for three years and running.   Through her, my husband and I got very well acquainted with the tremendous benefits breastfeeding offers as well as the challenges it poses. Also, I remember my sister-in-law who hand-carried my heavy breast pump all the way from US to Philippines and finally to Singapore when they came to visit. We are indeed lucky to have both families’ support.

A husband who believes that breast is best is most beneficial as there could be moments fatigue gets the better of you.  For me, I am very grateful that Alfred would take two night feedings (using my expressed milk) so I could sleep longer.   He also made sure I get to have my “me” time by spending plenty of bonding time with baby Ava.  The fact that he is also proud we exclusive breastfed our baby (stopped after 13 months, doctor’s advice after I got pregnant with our second) is an added inspiration that kept me going.

Natural birth = Alert Baby = Early Latch

I initially thought that my easy success with breastfeeding was all because of my knowledge, preparation and commitment.  Unbeknownst to me, I later realized that the effortlessness of it was also because of my decision to give drug-free natural birth.

Judith Lothian, a childbirth educator in Brooklyn, New York, and a member of Lamaze International Board of Directors believes that:

 “Normal, natural birth sets the stage for problem-free breastfeeding—what nature intended—while a complicated, intervention-intensive labor and birth set the stage for problems”.

This rang true to what I have experienced.  Since both Ava and me were very alert when she came out, she was able to latch successfully from the moment she came out.  Probably high from endorphins and oxytocin, I also had all the energy to carry and keep her close to me.  Indeed, I was walking by myself to the loo after giving birth!  It reminded me of Scarlett O’Hara from the novel “Gone with the Wind” when she said something like “I could give birth in the morning and go out for a tea in the afternoon”.

I strongly feel that when you do things as natural as it can be (sounds like Taoism), it is just as less complicated. No rocket science there.   

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